A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject?

In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the basic ethical requirements for research — the ability to consent.

“I can’t tell you empirically that it’s absolutely because [rural hospitals] manage tighter budgets but I can tell you anecdotally that they are doing it,” Morrow told Healthcare Dive. “They tend to be well run because they don’t have a whole lot of options — they are forced to manage on much smaller budgets.”

The secret, according to Morrow, is a focus on providing the right care in the right setting…

Registered nurses who work in nursing homes need to rely on their colleagues in hospitals to determine whether it’s necessary to refer nursing home residents to the emergency department (ED), according to a new study in the Open Journal of Nursing.

They found that when nurses had a distant relationship with their colleagues at hospitals or a previous negative experience, they often felt insecure and alone in their decision-making. Hospital staff, they said, would sometimes question their competence. As a result, they sometimes hesitated to refer patients to the ER and typically turned to their colleagues in the nursing home for advice.